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ZONING PERMIT NO. Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2015-00070 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> PHONE AGENT/CONTRACTOR NAME PHONE <br /> LINK K TR, CULLEN VITO (630)N <br /> L 543-3010 QUAM ENGINEERING, LLC (608)838-7750 <br /> ADDRESS(Number,Street) <br /> 3038 DR R G ADDRESS(Numbertreet) 4604 SIGGELKOW RD SUITE A <br /> 3038 <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON,WI 53589 MCFARLAND,WI 53558 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SJINK502 @AOL.COM RQUAM @QUAMENGINEERING.COM <br /> SECTION 1/4 1/41/4 <br /> PARCEL NO. TOWNSHIP 30 SE SW <br /> 0611-304-4023-3 TOWN OF PLEASANT SPRINGS <br /> STREET NAME ST.TYPE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION SHADYSIDE DR <br /> (Assignment of new address is <br /> 3038 <br /> subject to field verification.) <br /> LOT (BLOCK C.S.M.NO.or PLAT NAME <br /> 3 CRYSTAL SPRINGS PARK <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> R-3 Residence 11143 Description:SFR ADDITION AND INSTALLATION OF OPEN <br /> District GRATE RAMP+CONVERT GRAVEL DRIVEWAY TO <br /> nrurnnr.rn nnnc�c.Ti mr nTnnn ,ern <br /> App for a Residential Structure;App for Walkway/ SEWER <br /> PROJECT INFORMATION Sewer <br /> Stairs;App for Relocating Impervious Surfaces; <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> D YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> ® YES ❑ NO 0 YES ® NO 0 YES ® NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.4266 sq.FL 3974 <br /> Setback from Ordinary High Water Mark Water Body Name PERMIT FEE <br /> 79 LAKE KEGONSA $150.00 <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the ctne of <br /> the property. I certify that the work to be performed, as part of this zoning permit, will <br /> noted on the submitted plans and comply with the applicable zoning ordinances. <br /> nu understand and at failure <br /> ect <br /> to comply with any provision or condition of this permit renders this zoning permit <br /> enforcement action. <br /> I acknowledge that I am responsible for complying with State associated with open water can be difficult <br /> near or on wetlands, lakes, and streams. Wetlands that are not <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department <br /> Resources f Natural i aCe Resources web page at <br /> www.dnr.state.wi.us or contact the Departmen t of <br /> I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> County SIGNAT, 7 DATE: <br /> Owner&Agent hereby agree to comply with all Dane Coun � 'E: O '��' t <br /> Ordinances.Any unauthorized change from the information or /_ �� u 5—Z"/'''/ ---‘ <br /> plans submitted will invalidate the permit. J <br /> O.rICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED <br /> INITIALS INSPECTION DATE INITIALS 08/27/2015 HJH3 <br /> DATE REVIEWED INITIALS <br />